Diagnosis

Diagnosing your condition

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include:

A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.

Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain.

If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may monitor you on video while conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions.

Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test.

High-density EEG. In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG — about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures.

Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.

Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.

Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.

Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating.

A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.

Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results.

Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.

Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:

Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin.

Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.

Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.

EEG brain activity

EEG brain activity

An EEG records the electrical activity of your brain via electrodes affixed to your scalp. EEG results show changes in brain activity that may be useful in diagnosing brain conditions, especially epilepsy and other seizure disorders.

CT scanner

CT scanner

Pinpointing seizure location

Pinpointing seizure location

This example shows SPECT scans taken during and between seizures. The differences represent areas where blood flow increased during the seizure. Once identified, that location is fitted onto an MRI image of the brain.

Treatment

Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment.

Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications.

Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled.

Anti-seizure medications may have some side effects. Mild side effects include:

Fatigue

Dizziness

Weight gain

Loss of bone density

Skin rashes

Loss of coordination

Speech problems

Memory and thinking problems

More-severe but rare side effects include:

Depression

Suicidal thoughts and behaviors

Severe rash

Inflammation of certain organs, such as your liver

To achieve the best seizure control possible with medication, follow these steps:

Take medications exactly as prescribed.

Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.

Never stop taking your medication without talking to your doctor.

Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.

Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications.

Surgery

Epilepsy surgery

When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that's causing seizures.

Doctors usually perform surgery when tests show that:

Your seizures originate in a small, well-defined area of your brain

The area in your brain to be operated on doesn't interfere with vital functions such as speech, language, motor function, vision or hearing

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates, and complication rates with the procedure you're considering.

Therapies

Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy:

Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.

The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent.

Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.

Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates.

In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet — under close supervision of their doctors — and remain seizure-free.

Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet.

Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.

Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.

Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or your skull that sends electrical pulses to your brain and may reduce your seizures.

Vagus nerve stimulation

Vagus nerve stimulation

In vagus nerve stimulation, an implanted pulse generator and lead wire stimulate the vagus nerve, which leads to stabilization of abnormal electrical activity in the brain.

Deep brain stimulation

Deep brain stimulation

Deep brain stimulation involves implanting an electrode deep within your brain. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your chest. A wire that travels under your skin connects the device to the electrode.

Deep brain stimulation

Deep brain stimulation

A magnetic resonance imaging (MRI) scan of deep brain stimulation shows the location of electrodes placed in the brain.

Potential future treatments

Researchers are studying many potential new treatments for epilepsy, including:

Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are under investigation. These responsive stimulation or closed loop devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure.

Continuous stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation — continuous stimulation to an area of your brain below a level that's physically noticeable — appears to improve seizure outcomes and quality of life for some people with seizures. This treatment approach may work in people who have seizures that start in an area of the brain that can't be removed because it would affect speech and motor functions (eloquent area). Or it might benefit people whose seizure characteristics mean their chances of successful treatment with responsive neurostimulation are low.

Stereotactic laser ablation or stereotactic radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery may provide effective treatment when an open procedure may be too risky. In these procedures, doctors direct radiation at the specific area in the brain causing seizures to destroy that tissue in an effort to better control the seizures.

External nerve stimulation device. Similar to vagus nerve stimulation, this device would stimulate specific nerves to reduce frequency of seizures. But unlike vagus nerve stimulation, this device would be worn externally so that no surgery to implant the device is needed.

Pacemaker for epilepsy

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Understanding your condition can help you take better control of it:

Take your medication correctly. Don't adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.

Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.

Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly.

Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water, and rest if you get tired during exercise.

In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.

Coping and support

Uncontrolled seizures and their effects on your life may at times feel overwhelming or lead to depression. It's important not to let epilepsy hold you back. You can still live an active, full life. To help cope:

Educate yourself and your friends and family about epilepsy so that they understand the condition.

Try to ignore negative reactions from people. It helps to learn about epilepsy so that you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.

Live as independently as possible. Continue to work, if possible. If you can't drive because of your seizures, investigate public transportation options near you. If you aren't allowed to drive, you might consider moving to a city with good public transportation options.

Find a doctor you like and with whom you feel comfortable.

Try not to constantly worry about having a seizure.

Find an epilepsy support group to meet people who understand what you're going through.

If your seizures are so severe that you can't work outside your home, there are still ways to feel productive and connected to people. You may consider working from home.

Let people you work and live with know the correct way to handle a seizure in case they are with you when you have one. You may offer them suggestions, such as:

Carefully roll the person onto one side.

Place something soft under his or her head.

Loosen tight neckwear.

Don't try to put your fingers or anything else in the person's mouth. No one has ever "swallowed" his or her tongue during a seizure — it's physically impossible.

Don't try to restrain someone having a seizure.

If the person is moving, clear away dangerous objects.

Stay with the person until medical personnel arrive.

Observe the person closely so that you can provide details on what happened.

Time the seizures.

Be calm during the seizures.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist, such as a doctor trained in brain and nervous system conditions (neurologist) or a neurologist trained in epilepsy (epileptologist).

Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to be well-prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Keep a detailed seizure calendar. Each time a seizure occurs, write down the time, the type of seizure you experienced and how long it lasted. Also make note of any circumstances, such as missed medications, sleep deprivation, increased stress, menstruation or other events that might trigger seizure activity.

Seek input from people who may observe your seizures, including family, friends and co-workers, so that you can record information you may not know.

Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements that you're taking.

Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Also, because you may not be aware of everything that happens when you're having a seizure, your doctor may want to ask questions of someone who has witnessed them.

Write down questions to ask your doctor. Preparing a list of questions will help you make the most of your time with your doctor.

For epilepsy, some basic questions to ask your doctor include:

What is likely causing my seizures?

What kinds of tests do I need?

Is my epilepsy likely temporary or chronic?

What treatment approach do you recommend?

What are the alternatives to the primary approach that you're suggesting?

How can I make sure that I don't hurt myself if I have another seizure?

I have these other health conditions. How can I best manage them together?

Are there any restrictions that I need to follow?

Should I see a specialist? What will that cost, and will my insurance cover it?

Is there a generic alternative to the medicine you're prescribing?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions:

When did you first begin experiencing seizures?

Do your seizures seem to be triggered by certain events or conditions?

Do you have similar sensations just before the onset of a seizure?

Have your seizures been frequent or occasional?

What symptoms do you have when you experience a seizure?

What, if anything, seems to improve your seizures?

What, if anything, appears to worsen your seizures?

What you can do in the meantime

Certain conditions and activities can trigger seizures, so it may be helpful to:

Avoid excessive alcohol consumption

Avoid nicotine usage

Get enough sleep

Reduce stress

Also, it's important to start keeping a log of your seizures before you visit your doctor.

The epilepsies and seizures: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through. Accessed May 24, 2017.

Schachter SC. Evaluation and management of the first seizure in adults. https://www.uptodate.com/contents/search. Accessed May 24, 2017.

Seizure first aid. Centers for Disease Control and Prevention. https://www.cdc.gov/features/getseizuresmart/index.html. Accessed June 13, 2017.

Fisher RS, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for classification and terminology. Epilepsia. 2017;58:522.

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